Clinical Observation Of Traditional Chinese Medicine Combined With Percutaneous Transforaminal Endoscopic Discectomy In Treating Lumbar Disc Herniation Complicated With Modic Changes

Objective:Through clinical comparison,this study explores the clinical efficacy of ZhiKe GanCao decoction combined with percutaneous transforaminal endoscopic discectomy in the treatment of lumbar disc herniation with endplate Modic changes,and analyzed the traditional Chinese medicine in relieving residual symptoms and accelerating functional rehabilitation,to provide clinical reference for Chinese medicine participating in perioperative treatment.At the same time,by analyzing the extent of ODI score changes in patients treated with percutaneous transforaminal endoscopic discectomy,to demonstrate that different types of Modic changes are the risk factors affecting the efficacy of percutaneous transforaminal discectomy for lumbar disc herniation.Methods:According to the diagnostic criteria and inclusion criteria,a total of 56 cases of lumbar disc herniation with endplate Modic changes treated with percutaneous transforaminal endoscopic discectomy were collected from January 2018 to September 2018 in Suzhou Hospital of Traditional Chinese Medicine.Before drug intervention,56 patients were randomized according to the order of admission,28 patients in the treatment group and 28 patients in the control group.The treatment group was treated with ZhiKe GanCao decoction on the basis of postoperative routine treatment,the control group only received routine treatment after operation.On the first day,2 weeks,4 weeks,6 weeks,2 months,4 months,and 6 months after surgery,a total of 7 time points were observed and followed up,and the efficacy index was recorded.At the same time,patients who underwent percutaneous transforaminal endoscopic discectomy were divided into 12 patients in group A and 15 patients in group B according to Modic changes classification criteria.Among them,group A patients had Modic type I changes,group B patients combined with Modic type II changes.The ODI scores at the first day,2 months,4 months,and 6 months after surgery were statistically analyzed.Results:Before the comparison,there was no significant difference in age,gender,surgical segment,VAS score,ODI score,TCM symptom score and/or Modic classification(P>0.05),which was comparable.After the treatment of percutaneous transforaminal endoscopic discectomy,the VAS score and ODI score of all cases were significantly lower than those before surgery,and the difference was statistically significant(P<0.01).During the drug intervention,the efficacy scores of the two groups showed a downward trend as a whole.With the prolongation of time,the declines of the two groups were different,and the difference was statistically significant(P<0.05),among which the treatment group decreased greatly.Before the end of follow-up,the scores and declines of the two groups were similar,and the difference was not statistically significant(P>0.05).In terms of TCM syndrome scores,the scores of the two groups were significantly lower after treatment,and the difference was statistically significant(P<0.01).At the same time,the scores of the treatment group were significantly lower than those of the control group,the difference between the two groups was statistically significant(P<0.01).In terms of TCM syndrome efficacy index,the total effective rate was 91.67%in the treatment group and 62.96%in the control group.The difference between the two groups was statistically significant(P<0.05).After the treatment of percutaneous transforaminal endoscopic discectomy,the ODI scores of group A and group B showed a downward trend as a whole,and the time factor had a statistically significant effect on the ODI score(P<0.01),the interaction of group and time,group factors had no statistical significance on the ODI score(P>0.05).Conclusion:Percutaneous transforaminal endoscopic discectomy is an effective surgical procedure for lumbar disc herniation complicated with endplate Modic changes,and there is no significant correlation between short-term efficacy and endplate Modic changes.Percutaneous transforaminal endoscopic discectomy combined with ZhiKe GanCao decoction can significantly improve residual symptoms,accelerate the process of postoperative rehabilitation,improve the quality of life,and has a very positive effect on the prognosis of surgery.Therefore,the combination of percutaneous transforaminal endoscopic discectomy and ZhiKe GanCao decoction to treat lumbar disc herniation complicated with endplate Modic changes is complementary and has clinical value.